DSS Case #3. *Grant R. Kolar, M.D., Ph.D., °Terrence Holekamp , MD., Ph.D., *Richard Perrin, M.D., Ph.D. *Division of Neuropathology and °Department of Neurosurgery, Washington University in St. Louis. Disclosure. There are no financial relationships to disclose. Brief History Received.
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*Grant R. Kolar, M.D., Ph.D., °Terrence Holekamp, MD., Ph.D., *Richard Perrin, M.D., Ph.D.
*Division of Neuropathology and °Department of Neurosurgery, Washington University in St. Louis
Compression of 3rd ventricle
Bilateral thalamic T2 hyperintensities with homogeneous enhancement
Scattered nonspecific T2 hyperintensities in cortex
Several weeks later …
Showed abnormal venous channel (involving vein of Galen and confluence of sinuses) with arterialized flow
(right common carotid angiogram)
Re-review of MRI noted large vein (originally not reported)
Internal Cerebral Veins (paired) and Vein of Galen
Dural Arteriovenous Fistula (dAVF)
Right Occipital Artery
Borden-Shucart Type III tentorialdAVF (Zipfel type 3s)
Red = before treatment; Black = after treatment
Retrograde Flow and Enlargement of Veins
Chronic Regional Hypoperfusion
Matrix Metalloproteinase 9
Induction of VEGF
Chen L, Mao Y, et al. Local Chronic Hypoperfusion Secondary to Sinus High Pressure Seems to be Mainly Responsible fo the Formation of Intracranial Dural Arteriorvenous Fistula. 2009. Neurosurgery 64:973